The nutritional, immunological, and emotional benefits of breastfeeding have
long been discussed. This paper will address yet another benefit of
breastfeeding, that of reducing the risk of snoring and obstructive sleep apnea
(OSA).

Obstructive sleep apnea is a serious medical condition involving the ability
to breathe while sleeping. A simplified definition of OSA is the
stoppage/blockage of airflow for at least 10 seconds in the presence of
respiratory effort while sleeping. OSA is usually characterized by loud snoring,
daytime sleepiness, and interrupted sleep with periods of not breathing, which
usually end in a snort. Other symptoms of OSA in adults include high blood
pressure, morning headaches, depression, temperamental behavior, intellectual
deterioration, poor job performance, impotence in males, and short-term memory
loss. Symptoms in children include snoring, headaches, hyperactivity,
developmental delay, behavior problems, restless sleep, nightmares, bed wetting
(1-2) and attention disorders.(3)

How is OSA related to breastfeeding? Breastfeeding is important to the proper
development of the swallowing action of the tongue, proper alignment of the
teeth, and the shaping of the hard palate.(4-5) Bottle-feeding, pacifier use,
and infant habits such as excessive thumb-sucking, arm-sucking, etc., can cause
tongue thrusts and malocclusions. Occlusion and a high palate impact the flow of
air through the airway and thus may contribute to OSA.

Based on the results of a1973 survey,(6) the American Academy of Pediatric
Dentistry noted that 89 percent of children between the ages of 12 and 17 had
some form of occlusal disharmony, and that 16 percent of youth had such a
severe, handicapping malocclusion that treatment was mandatory. These figures
are staggering when compared to my skull research,(4) and that of others,(7-11)which shows that before the invention of the modern baby bottle about 200
years ago, people had minimal malocclusion or decay.

Labbok(12) has shown a direct relationship between length of breastfeeding
and occlusion; the longer the infant was breastfed, the better was the
occlusion. Other authors(13-20)have shown that bottle-feeding, pacifier
use and other habits can cause problems with breastfeeding or can lead to
malocclusion. Farsi(21) showed that the longer a child was breastfed, the lower
the incidence of digit and pacifier sucking. Hultcrantz(22) found that 6.2
percent of the children studied snored every night by the age of 4, and another
18 percent snored when they were sick. Among the snorers, more children used
pacifiers than among the non-snorers (60 percent vs. 35 percent).

An article published in 1997 by a sleep research team from Stanford describes
a formula for predicting OSA.(23)It states that individuals with high
palates, narrow dental arches, overjets (lower jaw retruded), and large necks
who are overweight are at risk for OSA. The information is extremely significant
when one realizes that evidence from skulls shows that before the invention of
baby bottles and pacifiers, high palates, narrow dental arches, and overjets
were rare.

A high palate can impact occlusion and breathing. It can also narrow the
upper dental arch and cause a crossbite. Since the roof of the mouth is also the
floor of the nose, any increase in the height of the palate decreases the volume
size of the nasal chamber. This decreased size can then increase the air
resistance through the nose. High palates also lead to a narrowing of the
posterior nasal aperture or choanae (skull opening at the back of the nose). A
smaller opening means a narrower beginning of the soft tissue section of the
airway. The narrower the beginning of the airway, the greater the risk of the
airway collapsing. Skulls from eras where there was universal breastfeeding
rarely have small posterior nasal apertures. Possibly, humans may not have had
OSA at all before the invention of artificial nipples.

Anything placed in a childís mouth excessively other than the motherís breast
can impact occlusion. The impact is affected by a number of factors, including
intensity, duration, and frequency. While the soft breast adapts to the shape of
the infantís mouth, anything firm requires the mouth to do the adapting.(24) In
addition, during breastfeeding, the tongue moves in a peristaltic motion
underneath the breast.(25-27) This motion is critical for the proper development
of swallowing, alignment of the teeth, and the shaping of the hard palate.
(Movement of the tongue is also a reason for clipping a tight lingual frenulum
in a newborn. This will allow the tongue to compress the breast and to develop
proper motion. By preventing this motion, a tight frenulum can lead to a tongue
thrust with a resultant malocclusion.)

Many factors, including heredity, influence malocclusion. Because of modern
medicine, babies who might have died in the past are now surviving, including
those with recessive genes that might impact occlusion. Other contributing
factors to malocclusion include: inter-cultural marriages, size differences in
parents, tight frenulums, tongue size, tonsil size, pathology, allergies,
central nervous dysfunction affecting facial muscles, and even diet.(7) These
factors alone, however, cannot account for the 89 percent rate of malocclusion
found in 1973. Infant habits appear to be a major contributing factor to
malocclusion.

The health and economic consequences of OSA are staggering. The best
prevention is breastfeeding and keeping objects like pacifiers out of the mouth.
Since craniofacial development is 90 percent complete by the age of 12,(28) it
is important to intervene early.(29-35) The prevention of OSA is yet another
reason that the public, health insurance companies, and health care
professionals should recognize the importance of breastfeeding.

15.
Paunio, P., P. Rautava, M. Sillanpaa. The Finnish family competence study: The
effects of living conditions on sucking habits in 3-year-old Finnish children
and the association between these habits and dental occlusion. Acta Odontol
Scand 1993; 51(1):23-9.

20.
Larsson, E.F. The Prevalence, Etiology and Effect on the Dentition of Initial
and Prolonged Fingersucking. in The Second International Symposium on
Feeding and Dento-Facial Development. Chicago. 1988.

Dr. Palmer is a private-practice dentist in Kansas City, Missouri. He has a
special interest in the treatment of snoring and obstructive sleep apnea and has
been doing self-funded research for more than 20 years on the collapse of the
oral cavity and airway, tight frenulums, and infant caries.

This article originally appeared in Breastfeeding Abstracts February
1999; 18(3):19-20. It is translated and reprinted with permission of La Leche
League International. The mission of La Leche League International is: To help
mothers worldwide to breastfeed through mother-to-mother support, encouragement,
information, and education and to promote a better understanding of
breastfeeding as an important element in the healthy development of the baby and
mother. For more information contact: